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The nursing profession has made some remarkable accomplishment during the 20th and 21st centuries, which has led to the recognition of nursing as an academic discipline. The move toward a theory- based practice has shifted the focus from the vocational view of nursing to a more meaningful and organized profession. As such, the knowledge and practice of nursing is embedded and guided by the theoretical framework of the profession. Theories also give direction and purpose to the nursing profession, and they are developed to improve nursing care and education, and to provide a basis for practice.
A theory is an idea recommended to explain a phenomenon, interprets observation, defines relationships, and project outcome (Parker & Smith, 2010). The theories of nursing can be categorize in three areas: (a) grand nursing theories, which gives abroad perspective to the goals and structure of nursing not meant to be easily grasp or tested, (b) middle range theories, contains fewer concept, and relationships are more applicable to nursing practice (c) practice level theories, which has more direct impact on nursing practice than more abstract theories.
Mid-range theories are both easily understood and applicable to the daily practice of nursing. For the purposes of this assignment, the core concepts of two middle range contemporary nursing theories will be highlighted and the concept definitions analyzed. One theory will be discussed along with its application to nursing practice, the theory’s concept statement, metaparadigms, philosophies, and conceptual model. Finally, nursing resources, and nursing knowledge from theorists are included in this paper to show the contributions to nursing science.
A concept is a word or ideas that provide a mental image to promote communication about a phenomenon and can be either empirical or abstract experience (Walker & Avant 2011). Core concepts are the fundamental building blocks in the development of theories, as such; theorists employ core concepts in the process of theory advancement (George, 2011). The metaparadigm of nursing is composed of four main concepts they are; person, health, environment, and nursing (George, 2011). The core concepts of the two contemporary nursing theories selected are Leininger’s culture care theory, and Kolcaba’s comfort theory. These theories are considered middle range theories because they are more understandable and easier to apply to day-to-day nursing practice and may be used to suggest an intervention.
Conversely, the grand theory is more extensive and provides a framework for organizing ideas (Smith & Liehr, 2008). Although health care has experienced numerous changes over the past decades, the basic principle of nursing, caring for the sick, has not changed. With the addition of evidence-based care as a result of nursing research and extensive research by nursing theorists there are additional components to nursing that nurses have to know and understand to provide excellent care. Unfamiliarity with someone else’s culture can lead to feelings of fear and insecurity due to differences in belief, values and practices (Leininger (1991). These theorists view the patient as a whole and believe care should be administered from a holistic approach.
Leininger is the innovator of the transcultural nursing movement in research, education, and practice. The overarching concept of this theory (culture) – based discipline is intended to serve individuals, communities, establishments, and societies. In the 1950s, while working in a child guidance home with troubled children and their parents, she observed repeated patterns of behavior in children that seemed to have a cultural basis. She identified these repeated patterns as the missing link in nursing understands of knowledge and culture care that is required to support compliance, wellness, and healing. As a result of this experience, she pursued further education in human behaviors that led to the development of her transcultural nursing theory (George, 2011). Leininger (1991) defines Transcultural nursing as “the comparative study of cultures to understand similarities (culture universal) and difference (culture-specific) across human groups” With this definition as the foundation for her work, Leininger focused her practice on cultural care values, practices, and beliefs of individuals or groups of different cultures. The goal of her theory is to provide nursing care that promotes health or well-being to help people faced with illness or death, in a culturally meaningful way (Leininger, 1995).
Transcultural nursing is established on the basis that people of different cultures not only define ways in which they perceive and experience care, but how they relate these perceptions, and experiences to their general health (George, 2011 ). Kolcaba worked as the head nurse on an Alzheimer patient care unit; she observed that patients were nonparticipants in some of their daily living activities. This observation led to her development of the Comfort Care Therapy. Kolcaba’s comfort theory gives nurses the tools required to identify the comfort needs of patients and families and ways to meet those needs. Comfort, she opined, is the purposeful action taken to address ones physiological, cultural, social, financial, spiritual, environmental and physical needs. Accordingly, if the patient needs time to voice concerns and questions, it is imperative that the nurse listens attentively and offers culturally appropriate encouragement and reassurance (Kolcaba, 2003).
The ideas of other nursing theorists (Orlando, Henderson, Patterson, and Zderdad) were employed to explain the three different types of comfort needs: (1)ease-the state of calm and contentment, (2) relief-the state of having specific comfort need met and transcendence, and (3) transcendence- that state in which one can rise above problems and pain( Parker & Smith, 2010). Because comfort is a primal human need, it must be experienced in a holistic manner, and nurses who practice comfort care in their daily routine are innovative, effective, and satisfying to themselves and their patients. The contexts in which comfort need exist are physical, psycho-spiritual, socio-cultural, and environmental. Nurses are responsible for ensuring that patients are comfortable and safe because meeting the comfort needs of patients and their families leads to increased satisfaction, dedication and commitment to the organization (Kolcaba, 2003). Transcultural and Comfort theories focus on different aspects of patient care; however, commonalities exist between the theories.
In comparing and analyzing the concept definitions among the two theories it is important to note that Leininger’s goal of nursing care is to provide care consistent with the patients’ cultural values, practices, and beliefs. Nurses are often unaware of the cultural issues surrounding a patient’s health and need for care which results in a lack of sensitivity towards the patient. According to Leininger (1995), cultural proficiency begins with the examination of personal values, biases, prejudices, and beliefs of the caregiver. Leininger’s theory was created to establish cultural competence among nurses and other caregivers because it is important to have contact and communication with people of other cultures, thus creating awareness. One important factor of nursing care is the engagement with individuals of different cultures by asking questions prior to providing care. The failure to include culture into patient care increases the possibility of mistrust by patient and resentment from the health care provider. Comfort and trust strengthen when nurses ‘consider cultural preferences during patient care (Andrews & Boyle, 1999).
Contrariwise, Kolcaba’s comfort theory is viewed from a holistic approach. The four areas of the human experience are addressed are the physical, which includes all physiological scopes, the psycho-spiritual, which is self-awareness, the sociocultural, which includes the family, interpersonal relationships, traditions, rituals, and religious practices and the environment( Kolcaba, 2003). Cultural sensitivities are important to patients and families, and they are allowing for significant moments to remember a nurse. Nurses also reflect on these moments which give them feelings of satisfaction. Nurses can show small, non-technical acts of comfort for example a back massage, holding a dying patients hand, washing hair, sitting with an anxious patient and holding a crying child for a parent. Each of these gestures is an example of holistic comfort measures that will have a positive impact on a patient’s total comfort (Kolcaba, 2003).
Like patients, nurses have comfort need which includes a safe and clean work environment, continuity of care, flexible schedules, and resources for educational improvement. Kolcaba’s comfort model allows nurses to be a part of the decision making process and in-turn provide feedback and support for staff. These comfort measures for nurses provide a strong nursing department and which teamwork and professional goals are fostered (Kolcaba, 2003). The core of these two theories is care, which is the unifying feature of the nursing profession.
Concept Statement, Metaparadigms, Philosophies
The selected theory is Leininger’s culture care theory. Leininger is one of the first transcultural, global, nursing consultant and is the founder of transcultural nursing, the transcultural nursing society, and the journal of transcultural nursing. Culture influences every aspect of human life and defines health, illness, and the search from relief from diseases (George, 2011). Culture can be applied to all aspects of health care both in inpatient and outpatient settings. Because of the culturally diverse population in the United States and other first world countries, it is of vital importance that culture care is a part of the curriculum for nursing and other health science related field.
Due to health concepts related to cultural groups, people may not choose modern day medical treatment and cures; therefore it is important to educate the communities about culture care. This theory may be best applied to nursing practice by first educating nursing students to develop an understanding, appreciation, and respect for the diversity and individuality of patients’ values, beliefs, and culture regarding illness, treatment and outcome. Extensive training in hospitals and outpatient settings for all nurses, and health care providers is of vital importance.
Culturally consistent nursing care is meaningful and appropriate to the cultural beliefs, values and traditions of patients for their health and comfort. Nurses should perform a culture care assessment on admission to determine the scope of care for the patient while in hospital (Leininger, 1995).
Health is a state of living to sustain and help the individual perform their daily care in a culturally beneficial way (Leininger (1995). The environment is defined as “the totality of geophysical situation” (p. 10). She describes nursing as a learned, humanistic and scientific discipline focused on human care activities. Leininger, however, does not define the concept of person; he states the person is not culturally suitable in many cultures. The philosophy of nursing is founded on the scope of practice for the profession, and the values individuals hold as basic to their belief in nursing theory (Fitzpatrick & Whall, 2005). Leininger’s philosophy is that there are similarities and differences in culture, which should be explores in relation to ones values, beliefs, and traditions.
A website has been dedicated to the housing of vast amount of information on Leininger’s theory. This site contains valuable information on culture theory and transcultural nursing. Additionally, Leininger’s work, research, and publications are all featured on the website. Leininger is a member of Sigma Theta Tau International (STTI), an honor society for nursing, was founded in 1922; it is the second largest of its kind in the United States. The mission of this organization is “to support the learning, knowledge, and professional development of nurses committed to making a difference in health care worldwide”.
The conceptual and theoretical models used in nursing provide information on ways to improve practice, develop curriculum and identify goals of nursing practice. The area of nursing theory is experiencing continued growth as theorists continue to create new knowledge that is impacting, positively, the nursing profession. Nurses can no longer afford to provide care as usual but must use new knowledge, skills, and insights to provide nursing care that is culturally relevant and sensitive to the needs of patients. As the complexity and acuity of patients continue to rise, it is notable that a community of practice is established that utilizes strategies that promote the transcultural and comfort needs of both nursing staff and patients. Twenty-first century nursing practice demands that nurses identify and meet the comfort and cultural needs of all patients, family and community. Further, nurses must develop the knowledge and skills that will enable them to provide acceptable care and to identify available resources for the patient.
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